Lane A
Hire through an agency
- The company recruits, screens, schedules and pays the caregiver.
- When someone calls in sick, you call the office instead of starting over.
- You still ask, in writing, who employs the caregiver and what the agency covers.
The hiring field guide, St. Louis metro
You lost a week to phone calls. Pick a lane, make the calls that count, and get someone in the house.
There are two ways to hire non-medical help at home. Each puts different paperwork on your desk and a different phone to ring at 6 a.m. when a shift falls through. Both are laid out here from public pages, with no prices and no pitch.
Lane B
Hire a person directly
- You find, interview and check the person yourself.
- You may become a household employer with IRS and Missouri filings.
- The schedule, the backup and the hard conversation are yours to hold.
Neither lane wins here. The table below shows what changes, row by row, with its source.
Before you call anyone
This week, in five moves
A legal pad and one evening. No company required.
Anything about his health, his medicines or how much care he clinically needs goes to his doctor. This desk covers the hiring.
- Write the day in four blocks. Morning, afternoon, evening, overnight. Next to each, what has to happen: the shower, lunch, the ride, the hours nobody is home. That page is your job description.
- Pick a lane on paper. Someone else screens, pays and replaces the caregiver: Lane A. You know a person and will be the employer: Lane B.
- Make the calls with the pad open. Ask who employs the caregiver, how they screen, who supervises, who covers a sick day, and whether there is a minimum shift. Write the answer, not the impression.
- Run the check. A Missouri caregiver can register with the Family Care Safety Registry, and an employer can then request background information. Ask any agency which checks it runs.
- Book the first shift for a day you can be there. Tape the routine and the numbers to the fridge, and keep a one-line log for 72 hours.
The fork, row by row
What changes with each lane
Every row comes from a public page opened on September 12, 2026, with the source in the last column. The dollar figures are tax thresholds and a state fee, quoted as printed. They are not prices for care.
| What changes | Lane A: through an agency | Lane B: a person you hire | Source |
|---|---|---|---|
| Who is the employer | Screening, hiring, pay and taxes run through the agency. Some act as employment agencies whose workers are contractors, so ask. | You handle hiring, firing and payroll taxes. The IRS says a worker found through an agency's list can still be your employee if you control what work is done and how. | Family Caregiver Alliance, IRS Pub. 926 |
| Federal employer taxes | Confirm the caregiver is on its payroll, not yours. | Social security and Medicare taxes apply at $3,000 or more in cash wages to one household employee in 2026. Federal unemployment tax applies at $1,000 in any calendar quarter of 2025 or 2026: 6% of the first $7,000. Schedule H, an EIN and a Form W-2. | IRS Pub. 926, IRS Topic 756 |
| Missouri unemployment | The employer company reports it. | An employer of a household worker in a private home becomes liable when it pays $1,000 in cash wages in a calendar quarter. | Missouri Division of Employment Security |
| Background checks | Most agencies have done background checks; ask. Missouri law requires certain providers to check criminal history and the Employee Disqualification List, plus two registries for in-home services providers. | Essential when hiring privately. The worker registers with the Family Care Safety Registry ($15.00 plus $0.55 online); you then request results at 866-422-6872, weekdays 9:00 a.m. to 3:00 p.m. The criminal search covers Missouri open records only. | Family Caregiver Alliance, FCSR providers, FCSR background |
| Backup coverage | You can ask the agency to send someone else. Ask how it covers a missed shift. | Yours to find. Write a second name before the first shift. | Family Caregiver Alliance |
| Who supervises | Ask how it trains, supervises and monitors its workers. | You do: the schedule, the notebook, the hard conversation. | Family Caregiver Alliance |
| State license | Missouri issues no license for private duty companies, and no physician order is needed for personal care, respite or companion care. Your questions are the screen. | Nothing to look up. The interview, references and registry are the screen. | Missouri DHSS, three types of care |
| Insurance | Ask what it covers: payroll, liability insurance, workers' compensation. | Check your homeowner's policy for liability coverage; you may need to add it and workers' compensation. | Family Caregiver Alliance |
This is a map, not tax or legal advice. For your own filings, read sheet 05 and then ask a tax professional.
What you are hiring
What a non-medical shift looks like
Shifts, not drop-ins
Missouri describes private duty care in shifts of four or more hours, with no limit on amount set by anyone but the family. Plan in blocks: a morning, an evening, a night.
The work itself
Bathing, dressing, meals, laundry, bed to chair, company, errands. Where nursing starts is the doctor's call. Sheet 14 lists the job.
Overnight and respite
Write down what happens at 2 a.m. The National Institute on Aging says respite care can last from a few hours to several weeks.
The sheets
Eighteen sheets, in the order the hiring happens
One question per sheet. Read the step you are on, or start here for the whole path.
-
1
Pick a lane
- Agency vs independent caregiver: which is better for an elderly parent?The two lanes side by side, with no verdict and no price.
- Non-medical home care vs home health: what is the differenceSkilled visits are not a person in the house at 2am.
- If I hire a caregiver myself, do I have to pay taxes?IRS Publication 926 and Missouri unemployment: a map, not advice.
- How do I hire an in-home caregiver for my mother who lives alone?The tasks, the lane, the check, the first shift.
- Hiring a private caregiver instead of an agency: the tradeoffs, with no verdictFamily Caregiver Alliance's pros and cons, with no winner.
-
2
The phone call and the interview
- 3
-
4
Hours and the first 72 hours
- How many hours a week does my mom need a caregiver?Walk the house and turn it into blocks.
- Can I hire a caregiver for just a few hours a day?A block, not a drop-by.
- Is there a minimum number of hours for in-home care?How to ask, without an invented number.
- How fast can a home care agency start after the first callWhat to have ready for the assessment visit.
- How soon can I get a caregiver for my dad this week?The shift grid and the exact question.
- What does a non-medical caregiver actually do during a shift?The job, and where nursing starts.
- What happens on the first day a caregiver comes to the houseThe fridge sheet and a 72-hour log.
-
5
When it is not working
Numbers for the pad
St. Louis and Missouri help for this week
Each number was printed on the linked official page on September 12, 2026. None of them hires for you. Local help adds tax, legal and veterans lines.
Aging Ahead
Area agency on aging for St. Louis County and three neighbors.
(800) 243-6060agingahead.orgSt. Louis Area Agency on Aging
Inside the city limits. Weekdays, 8 to 5.
(314) 612-5918stlouis-mo.govMissouri Senior Resource Line
Enter a ZIP; it transfers you locally.
1-800-235-5503health.mo.govEldercare Locator
Federal directory of local services.
1-800-677-1116eldercare.acl.govMissouri HCBS referral
Initial referral for state in-home services.
1-866-835-3505health.mo.govFamily Care Safety Registry
Background requests. Weekdays, 9 to 3.
(866) 422-6872health.mo.govAdult Abuse and Neglect Hotline
Daily, 7 a.m. to 8 p.m.
1-800-392-0210health.mo.govAttorney General Consumer Protection
For a dispute with a company.
1-800-392-8222ago.mo.gov
Asked at the kitchen table
Five questions, answered short
If I pay a caregiver myself, do I owe taxes?
Possibly. The IRS thresholds for 2026 are $3,000 in cash wages to one household employee for social security and Medicare, and $1,000 in a calendar quarter for federal unemployment tax. Ask a tax professional about your household.
Can I run a background check on a caregiver in Missouri?
Yes, once the worker registers with the Family Care Safety Registry. Request results at 866-422-6872 on weekdays, by form or online. The criminal search covers Missouri only.
Is an agency safer than the person my neighbor knows?
This desk will not pick. An agency usually screens, pays and replaces the caregiver; a direct hire puts that on you. The table shows each difference.
What do I do when the caregiver does not show up?
With an agency, call the office and ask for someone else. With a direct hire the backup is yours, so name a second person before the first shift.
Will Medicare pay for someone to be in the house with Dad?
Not when personal care and company are all he needs. Home health is skilled care, a different product. Sheet 04 explains.
Paid placement, disclosed
If Lane A is your lane, here is one name for the pad.
Bring the four blocks you wrote down. A real person will talk through which shifts could be covered, even if it starts with a few hours.
New Plan Care Solutions is locally owned and run by Stacie Postol in Chesterfield, serving St. Louis and St. Charles counties. Caregivers are background-checked, and care plans are built with the family and changed when life changes: personal care, companionship, homemaking and respite.
Disclosure: New Plan Care Solutions is a client of this site's publisher and compensates us for this placement. It is the only provider featured here, and the guides on this site are educational, not medical advice.
Received. New Plan Care Solutions will contact you only in the way you asked. If it is urgent, call or text (314) 405-0887.